UPMC Physician Resources

Improved Pediatrician/Parent Communication Could Yield Stronger Adolescent Health Outcomes, Pitt Study Finds

PITTSBURGH, Nov. 26, 2013 – Improved communication between pediatric providers and the parents and guardians of adolescents could lead to better health outcomes, a University of Pittsburgh School of Medicine study reports. The findings are available online in this month’s Patient Education and Counseling.

Between June and November of 2009, Aletha Akers, M.D., assistant professor of obstetrics and gynecology at Pitt and the study’s lead author, and her research team administered an anonymous, self-reported questionnaire to a sample of 358 parents accompanying their adolescent children on visits to general outpatient pediatric clinics at Children’s Hospital of Pittsburgh of UPMC to assess the main health issues concerning their adolescents.

The questionnaire relied on the parent or guardian’s ability to recall their conversations with their adolescent’s health care provider on a range of preventive health topics including nutrition, mental health, physical activity, sexual activity and substance abuse. According to Dr. Akers, most parents could recall discussing at least one adolescent preventive health topic with their adolescent’s care provider. They were much more likely to recall discussing general prevention topics like physical activity and nutrition than they were to recall discussing more sensitive topics like sexual activity, substance abuse and mental health issues.

“Adolescence is a relatively healthy period of life, and most adolescent morbidity comes from participating in high-risk behaviors. Most preventive health conversations between parents and providers take place during early childhood, but such communication is arguably even more important during the adolescent years, when adolescents’ health choices could directly influence health outcomes,” said Dr. Akers.

“Ideally, these results are the first step toward improving communication between pediatric care providers and parents and guardians,” Dr. Akers added. “By building on tools we already have in place, we can improve conversations about high-risk health behaviors, including incorporating screening and counseling practices into acute care visits or visits for school physicals, since many adolescents miss their annual well-child check-ups. The use of electronic medical records can remind care providers of essential health topics that need to be discussed with adolescents and their guardians.”

This study was funded by the National Institutes of Health grant number KL2 RR024154-03, and by the Robert Wood Johnson Foundation.

Joel Schuman, MD, Interviewed by the Macular Degeneration Foundation

During the American Academy of Ophthalmology annual meeting, Joel Schuman, MD, was interviewed by the Macular Degeneration Foundation about the cutting edge programs at UPMC and the Fox Center for Vision Restoration. Watch Dr. Schuman’s full interview:

Please direct any follow up questions for Dr. Schuman to EyeCenter@upmc.edu

Children’s Community Pediatrics Now Offers 24/7 Access to Care for Common Illnesses through On-line Video Appointments

PITTSBURGH, Nov. 25, 2013 – Families in Pennsylvania now can access Children’s Community Pediatrics (CCP) board-certified pediatricians for many common illnesses day or night through a virtual visit using a computer with a webcam.

These new pediatric virtual visits, part of UPMC AnywhereCare, are just one part of an expanded MyUPMC.com online patient portal providing access to UPMC’s world-class care to anyone located in Pennsylvania. Through UPMC AnywhereCare, children ages 3 and older can be evaluated and receive treatment for many common symptoms and diagnoses from CCP pediatricians through a video connection 24 hours a day, seven days a week.

MyUPMC.com builds on UPMC’s existing patient portal known as UPMC HealthTrak. Parents seeking a Children’s AnywhereCare visit for their child will need to have a “proxy” relationship established prior to seeking online care. The proxy provides parents with access to view their child’s health information online and access online care. Parents who do not have a UPMC HealthTrak account or established proxy can sign up online at https://myupmc.upmc.com or speak with their CCP provider.

After requesting a virtual visit through the portal, a scheduler will call within 15 minutes and schedule a video appointment with a board-certified CCP pediatrician, typically within one hour. Conditions that currently are being evaluated and treated are cold, cough and conjunctivitis (pink eye). The cost of a UPMC AnywhereCare visit is a flat fee of $38. Patients who have UPMC Health Plan coverage may pay a lower co-pay amount for their child’s virtual visit.

“These conditions might not rise to the level of a trip to the emergency department, or even to the physician’s office, but can be challenging for families to deal with because it can cause kids to miss time from daycare or school and parents to miss time from work for appointments,” said Kathy Guatteri, president, CCP. “UPMC AnywhereCare allows them to have their children evaluated by a board-certified CCP pediatrician with quick, convenient access to treatment. It also can provide continuity of care with a child’s CCP pediatrician, since the virtual visit automatically becomes part of the child’s electronic record at UPMC.”

For more information or to schedule a UPMC AnywhereCare virtual appointment, please visit https://myupmc.upmc.com/.

Teens Who Drink Alone More Likely To Develop Alcohol Problems as Young Adults, University of Pittsburgh, Carnegie Mellon Researchers Find

PITTSBURGH, Nov. 18, 2013 – Most teenagers who drink alcohol do so with their friends in social settings, but a new study by researchers at Carnegie Mellon University and the University of Pittsburgh reveals that a significant number of adolescents consume alcohol while they are alone.

Published in an upcoming issue of Clinical Psychological Science, the researchers found that compared to their peers who drink only in social settings, teens who drink alone have more alcohol problems, are heavier drinkers and are more likely to drink in response to negative emotions. Furthermore, solitary teenage drinkers are more likely to develop alcohol use disorders in early adulthood.

“We’re learning that kids who drink alone tend to do so because they’re feeling lonely, are in a bad mood, or had an argument with a friend,” said lead author Kasey Creswell, Ph.D., assistant professor of psychology in CMU’s Dietrich College of Humanities and Social Sciences, who completed the research while at Pitt. “They seem to be using alcohol to self-medicate as a way to cope with negative emotions and, importantly, this pattern of drinking places them at high risk to escalate their alcohol use and develop alcohol problems in adulthood.”

Previous research has shown that adolescents who drink alone consume more alcohol and drink more frequently than their social-drinking peers, and that heavier alcohol use in adolescence is associated with a greater risk of developing alcohol problems in adulthood. This study is the first to determine whether solitary drinking during teenage years impacted the development of alcohol use disorders as young adults, after controlling for other known risk factors.

For the study, the researchers first surveyed 709 adolescents between the ages of 12 and 18 at the Pittsburgh Adolescent Alcohol Research Center (PAARC), asking them to report on their alcohol use in the past year. Adolescents represented youth from clinical treatment programs and the community. When the participants turned 25, they were again asked about their alcohol use and assessed for alcohol use disorders. The results showed that 38.8 percent of teens in the sample reported drinking alone during ages 12 to 18. This behavior was linked to unpleasant emotions, and solitary drinkers were one-and-a-half times more likely to develop alcohol dependence at age 25.

“Because adolescent solitary drinking is an early warning sign for alcohol use disorder in young adulthood, and solitary drinking tends to occur in response to negative emotions, youth who report solitary drinking might benefit from interventions that teach more adaptive strategies for coping with negative emotions,” noted Tammy Chung, Ph.D., associate professor of psychiatry and epidemiology, University of Pittsburgh School of Medicine, and co-author of the study.

The National Institute on Alcohol Abuse and Alcoholism and National Institute on Mental Health funded this research.

For more information, visit http://www.psy.cmu.edu/people/creswell-kasey.html.

Breast Cancer Research Foundation Continues Support of Pitt Investigators with New Funding for Personalized Medicine Research

PITTSBURGH, Nov. 18, 2013 – In the last five years, the Breast Cancer Research Foundation (BCRF) has provided research support for scientists at the University of Pittsburgh Cancer Institute (UPCI) and Magee-Womens Research Institute (MWRI) with nearly $2 million in funding for breast cancer research with the potential for clinical application. That support continues this year with $720,000 provided to three researchers investigating ways to improve treatment and survival outcomes for women with breast cancer.

Nancy E. Davidson, M.D., director of the University of Pittsburgh Cancer Institute and UPMC CancerCenter; Adrian V. Lee, Ph.D., director of the Women’s Cancer Research Center (WCRC), a collaboration between UPCI and MWRI; and Steffi Oesterreich, Ph.D., director of education at WCRC, have each received $240,000 from the foundation this year. The awards are part of $45 million in grants to breast cancer researchers announced at the BCRF 2013 Symposium and Awards Luncheon in October.

Dr. Davidson’s laboratory will use the funds to continue studying the role of epigenetic changes in breast cancer development and therapy.

“We know that breast cancer results from an accumulation of genetic and epigenetic changes in the cancer cell. Because epigenetic changes alter gene activity but not the genes themselves, they potentially could be reversed. We are evaluating ways to counteract these changes as a new way to treat breast cancer,” said Dr. Davidson, a recipient of BCRF funding for 15 years.

The goal of Dr. Lee’s laboratory is to improve the prediction of breast cancer prognosis and its response to treatment. His first award from BCRF will support research investigating the differences found within breast cancers.

“We’ve known for some time that there are different types of breast cancers,” said Dr. Lee. “Now we are trying to understand how differences within the breast cancer tumor operate. One tumor can have an area of aggressive disease and an area of benign disease. We need to determine the importance of the aggressive disease. Understanding the differences within breast cancer tumors will help us refine personalized treatment approaches for breast cancer patients.”

This is the third consecutive year Dr. Oesterreich has received an award from BCRF supporting her research investigating invasive lobular carcinomas (ILC), which represent 30,000 cases of breast cancer each year.

“The study of ILC-related breast cancer currently is underfunded, so the support I receive from BCRF is particularly important,” said Dr. Oesterreich. “Currently, patients with this type of breast cancer receive the same type of treatment as patients with other subtypes of the disease, but some patients with ILC don’t respond as well to endocrine therapy. We hope improved understanding of the disease will lead to better, targeted treatment for patients.”

In addition to the grants awarded this year, the BCRF provided the initial funding for the Women’s Cancer Research Center.

“Without the support of the BCRF, our breast cancer research wouldn’t be nearly as robust as it is,” said Dr. Davidson. “We share the vision of a future free of breast cancer, and this funding will bring us one step closer to that goal.”

Children’s Hospital of Pittsburgh of UPMC Opens Pediatric Inpatient Rehabilitation Unit

PITTSBURGH, Nov. 18, 2013 – Children’s Hospital of Pittsburgh of UPMC Rehabilitation Institute will open an eight-bed pediatric inpatient rehabilitation unit this week. The unit will provide continuity of care as well as maximize the health and functional outcomes of children after injury, illness or surgery.

The Children’s Hospital inpatient rehabilitation unit will be located at The Children’s Home & Lemieux Family Center, less than one mile from Children’s main campus on Penn Avenue in Lawrenceville. The unit will be called the Children’s Hospital Rehabilitation Unit (CHRU).

While the CHRU is not located inside Children’s Hospital, it is a Children’s Hospital unit and will raise Children’s licensed bed count from 296 to 304. The CHRU will operate under Children’s policies and procedures, be staffed by Children’s employees, and physicians from all specialties at Children’s will be available for consultation.

“The CHRU will bring together a team of experts from multiple disciplines to offer advanced therapeutic treatments for our patients,” said Amy Houtrow, M.D., Ph.D., M.P.H., medical director of Children’s Hospital’s Rehabilitation Institute and of the CHRU. “We plan to provide continuity of care to children and adolescents needing intensive rehabilitation services, and to provide high-quality, comprehensive rehabilitation services to pediatric patients. One of the benefits to patients will be the ready access they will have to every medical and surgical subspecialty at Children’s.”

Candidates appropriate for the CHRU include children and adolescents with acquired brain injury; amputation; disabling neurological conditions; medically and/or surgically complex conditions with weakness after a prolonged illness or hospitalization; polytrauma, or multiple trauma; and spinal cord injury. Every referred patient from Children’s will be evaluated by a rehabilitation coordinator, who will give the family other options if the child is not determined to be appropriate for the CHRU.

The CHRU will be staffed by experts in these fields:

  • Audiology and Speech-Language Pathology
  • Behavioral Psychology and Neuropsychology
  • Care Management
  • Child Life and Recreational Therapy
  • Occupational Therapy
  • Physical Therapy
  • Recreational Therapy
  • Rehabilitation Coordination
  • Social Work
  • Special Education

“This is exciting for Children’s because we will now have the opportunity to see pediatric patients through their entire hospital journey; all the way to their return to home, school and the community, which will improve continuity of care,” Dr. Houtrow said.

Location information:

Children’s Hospital Rehabilitation Unit
5324 Penn Avenue
Pittsburgh, PA 15224

For more information on the CHRU, please call 412-692-9800 or visit www.chp.edu/chru.

Magee Surgeon First in the Region to Perform a Robotic Single-Site Hysterectomy

PITTSBURGH, Nov. 15, 2013 Magee-Womens Hospital of UPMC recently became the first hospital in western Pennsylvania to perform a hysterectomy through a single incision using robotic technology. This nearly scar-free surgical option provides women with a state-of-the-art, minimally invasive approach to gynecological surgery.

Alexander Olawaiye, M.D., a gynecologic oncologist at Magee, last week performed a hysterectomy by removing the patient’s uterus through one incision in the belly button. He and his team performed the hysterectomy using the da Vinci® surgical system.

Prior to advances in first laparoscopic, and now robotic, surgery, women requiring hysterectomy could sometimes take weeks to recover, and they often had significant scarring on their abdomens.

Recently approved by the Food and Drug Administration, single-site robotic surgery offers the traditional benefits of minimally invasive surgery, including shorter recovery times, smaller incisions, less pain and blood loss, and shorter hospital stays. It also provides the additional benefit of a single incision site, so women are left with one, nearly invisible scar.

“Performing hysterectomies robotically, when appropriate, allows us the ability to conduct complex surgeries in a minimally invasive way,” said Dr. Olawaiye. “Robotic, single-site hysterectomy offers a reduction in pain and recovery time, and comes with the added benefit of minimal scarring.”

Magee surgeons regularly perform bariatric, gynecologic and urologic surgeries robotically. Recently, Magee acquired a second robot to meet the hospital’s growing surgical demands.

“At Magee, the ability to provide women in western Pennsylvania a variety of advanced surgical options and experienced surgeons is part of our commitment to the best possible health of our patients,” added Dr. Olawaiye.

Pitt Team Aims to Change Tissue Microenvironment to Fend Off Cancerous Tumors

PITTSBURGH, Nov. 14, 2013 – The magic to killing cancer cells might not be in the bullet, but in the gunpowder that accompanies it, according to researchers at the University of Pittsburgh Cancer Institute (UPCI), partner with UPMC CancerCenter. Instead of developing new drugs that directly target tumors, they have been working on adjuvant agents that alter the immunological microenvironment around the tumor to boost the effectiveness of existing drugs and the effectiveness of each patient’s immune responses against cancer.

While multiple studies worldwide have demonstrated that the infiltration of tumor tissues with immune killer cells called cytotoxic T cells (CTLs) improves the prognosis of cancer patients, it remains unclear how to manipulate tumor microenvironment to promote CTL infiltration.

In a recent presentation at the Cancer Vaccines and Gene Therapy Meeting in Malvern, Pa., Pawel Kalinski, M.D., Ph.D., professor of surgery, University of Pittsburgh School of Medicine, presented laboratory data in support of the clinical use of “combinatorial adjuvants” that induce desirable patterns of tumor-associated inflammation and result in CTL infiltration into tumors. He also discussed preliminary data from a phase I/II trial led by Amer Zureikat, M.D., an assistant professor of surgery at Pitt, in which colorectal cancer patients were given escalating doses of interferon alpha (IFN-α) in combination with a COX2 blocker and Ampligen®, an experimental toll-like receptor-3 (TLR3) ligand, factors that synergistically enhance IFN-α’s immunological effects in tumor microenvironments.

“The first part of the trial is not complete, but so far it appears that the treatment was well-tolerated,” Dr. Kalinski said. “Our early observations are completely consistent with our preclinical predictions and hint that the combination therapy may be altering the tumor environment to make it more susceptible to immune attack. We are hopeful that the next, randomized part of the study will directly demonstrate the difference between the tumors of patients receiving standard treatment of chemotherapy and surgery and the patients receiving additional immunotherapy, which would lead us to expect a therapeutic benefit to this strategy.”

Tumors are typically able to undermine the body’s immune defenses, sending out cellular signals that call in regulatory T-cells to suppress the activity of natural killer cells, he explained. While there are many adjuvants available to enhance immune system response, most are nonselective and, therefore, ineffective. Preclinical experiments conducted by Dr. Kalinski’s team indicate that the combination of IFN-α, a COX2 inhibitor and TLR3 ligands selectively brings the right kinds of immune cells to the tumor to produce what he calls “good inflammation.” Such a treatment preferentially induces good inflammation within tumors, allowing the immune system to selectively attack cancer cells without inadvertently harming healthy tissues nearby.

In the second part of the study, which could begin at the beginning of next year, colorectal cancer patients will be randomly assigned to receive either conventional treatment with chemotherapy followed by surgical removal of the tumor, or to additionally receive two cycles of the IFN-α-based chemokine-modulatory regimen between chemo and surgery.

“After surgery, we will be able to compare the tumors from the two groups to see if there is a difference in their immunological microenvironment that could be beneficial,” Dr. Kalinski said. “This adjuvant strategy might also work for many other kinds of cancers because it’s not targeting specific tumor markers, but boosting the immune system’s own ability to find cancer cells and destroy them.”

He added that future efforts would aim to add a vaccine component based on dendritic cells, which recognize foreign proteins to stimulate an immune response against them. That strategy, too, would rely on boosting the body’s own defenses rather than providing a specific tumor marker as a target.

The project is funded by National Institutes of Health grants 1PO1CA132714. Doses of Ampligen were donated to the study byHemispherx Biopharma Inc.

Children’s Hospital of Pittsburgh of UPMC Receives $50,000 Childhood Cancer Research Grant from the St. Baldrick’s Foundation

PITTSBURGH, Nov. 14, 2013 Linda M. McAllister-Lucas, M.D., Ph.D., chief, Division of Pediatric Hematology/Oncology at Children’s Hospital of Pittsburgh of UPMC, has been awarded a one-year, $50,000 grant from the St. Baldrick’s Foundation, a volunteer-driven charity dedicated to raising money for childhood cancer research.

Dr. McAllister’s is one of 39 infrastructure grants awarded by the Foundation’s fall grant cycle, totaling more than $2.2 million in pediatric oncology research. These grants provide resources to institutions to conduct more research and enroll more children in ongoing clinical trials.

“This grant will allow our program to perform Phase I clinical trials aimed at identifying new and improved treatment options for childhood cancer,” said Dr. McAllister. “Our team has an excellent record of study compliance and patient safety, and the St. Baldrick’s grant allows us to support a clinical research nurse on the team.”

Dr. McAllister, also professor of pediatrics at the University of Pittsburgh School of Medicine, came to Pittsburgh in January 2013, bringing a rich background in research, clinical care and teaching to the hospital, its patients and the university.

“While fewer than 5 percent of adults with cancer participate in clinical trials, more than 60 percent of childhood cancer patients receive their treatment as part of clinical trials, which are designed to offer the best cutting-edge treatments, or treatments that may be even better than today’s standard,” said Kathleen Ruddy, chief executive officer for the St. Baldrick’s Foundation. “The St. Baldrick’s Foundation is proud to fund this latest round of infrastructure grants, many of which will make more clinical trials available for children closer to their homes. This offers today’s patients more hope and tomorrow’s patients more progress through research.”

Children’s Hospital of Pittsburgh of UPMC is a member of the Children’s Oncology Group and is one of 13 centers nationwide to be selected as a Phase I research center. Children’s Hospital also is a member of the Pediatric Brain Tumor Consortium, a select group of institutions with leading neuro-oncology clinical trial capability.

For more information about Dr. McAllister, please visit www.chp.edu.

NIH Grant Funds Multicenter Study of Mysterious Trauma-Induced Hemorrhaging

PITTSBURGH, Nov. 14, 2013 – Stephen Wisniewski, Ph.D., senior associate dean and co-director of the Epidemiology Data Center at the University of Pittsburgh Graduate School of Public Health, will coordinate a new, multicenter, multidisciplinary effort – supported by a five-year, $23.8 million National Institutes of Health (NIH) grant – to study a deadly bleeding syndrome called coagulopathy, which occurs without warning in some trauma patients.

Led by University of Vermont Professor Emeritus of Biochemistry Kenneth Mann, Ph.D., the Trans-Agency Consortium for Trauma-Induced Coagulopathy (TACTIC) study is a cooperative effort funded by the National Heart, Lung, and Blood Institute (NHLBI) that establishes a unique collaboration between the NIH and the Department of Defense (DOD).

“Multiple, parallel research projects will each explore a different side of coagulopathic syndromes in an effort to discover why they occur and, ultimately, to explore ways to treat and prevent them,” said Dr. Wisniewski, also professor of epidemiology. “Those projects will produce a massive amount of data, something we at Pitt Public Health are well-equipped to collect, analyze and organize into useful information.”

Trauma is the major cause of death in people less than 34 years old and the third-leading cause of mortality in the United States, with uncontrollable hemorrhage representing the major cause of preventable deaths, according to the NIH. Each year, nearly 50 million traumatic injuries in the U.S. result in 170,000 deaths.

Little is known about the biological phenomena that lead to coagulopathy. When a person sustains a traumatic injury, some, regardless of proper treatment, can suddenly suffer from uncontrolled bleeding and die. It is believed that the shock from the trauma induces a “storm” of coagulation and inflammatory problems that prevent their blood from clotting.

“There are no analytical tools that allow emergency department staff to conclude that coagulopathy is occurring in trauma victims. We’re starting from ‘ground zero,’” Dr. Mann explains. “The physicians and staff are left without resources to guide an effective therapeutic approach.”

Study co-leader Charles Esmon, Ph.D., the Lloyd Noble Chair in Cardiovascular Biology at the Oklahoma Medical Research Foundation, will look at the role played by DNA and histones that escape from cells in initiating the inflammatory and coagulation abnormalities that occur in trauma.

“We’ve gathered the leading minds in the field to attack a problem that has a serious and immediate impact on patients,” said Dr. Esmon. “To understand and address the issue of severe trauma, we need a multidisciplinary approach. This project requires experts in clinical science, basic biology, laboratory science and animal research.”

This trans-agency endeavor links the NHLBI-supported TACTIC program with DOD clinical trauma research centers in a unique initiative that integrates laboratory, clinical and early translational, hypothesis-driven research by leading investigators across the country and enables the basic science investigative units to explore clinical specimens obtained from the DOD centers.

Additional institutions involved in the research funded by the TACTIC grant include Massachusetts Institute of Technology, Mayo Clinic, Scripps Research Institute, University of California-San Francisco, University of Illinois and University of Pennsylvania. DOD-supported institutions participating in the clinical component of the TACTIC grant include University of Colorado, University of Pittsburgh and Virginia Commonwealth University.

This research is funded by NIH grant UM1 HL120877-01.

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